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Series on pharmacy benefit managers makes complicated topic easier to understand

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Thomas Hawk via Flickr

One of the most complicated topics to cover in health care today is the role of pharmacy benefit managers (PBMs). Employers and health plans hire these middlemen to manage their prescription benefit programs for workers and health plan members.

Not only do PBMs contract with health plans, but some large health plans, notably UnitedHealthcare which owns Optum, have their own PBMs. Late last year, CVS Health, one of the nation’s largest retail pharmacy chains and owns Caremark, a PBM, said it would buy Aetna, one of the country’s largest health insurers. That deal is pending regulatory review, as Bruce Japsen reported for Forbes early this month. Continue reading